Provider Demographics
NPI:1689949273
Name:NAMASTE OB/GYN, LLC
Entity Type:Organization
Organization Name:NAMASTE OB/GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-815-8800
Mailing Address - Street 1:159 OMNI DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-0302
Mailing Address - Country:US
Mailing Address - Phone:931-815-8800
Mailing Address - Fax:
Practice Address - Street 1:159 OMNI DR STE 1
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-0302
Practice Address - Country:US
Practice Address - Phone:931-815-8800
Practice Address - Fax:931-815-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528595Medicaid
TN1528595Medicaid